%0 Journal Article
%T Influence of the Type of Basal Insulin and Other Variables on Clinical Outcomes in Children with Newly Diagnosed Type 1 Diabetes
%A Ruth M. Garrison
%A Jeremy L. Johnson
%A Michelle E. Condren
%A Kevin C. Farmer
%A David H. Jelley
%J ISRN Pediatrics
%D 2014
%R 10.1155/2014/758343
%X Background. Basal insulin detemir and glargine each have characteristics that may make them a superior choice in children and adolescents with type 1 diabetes, but there is a paucity of data on glycemic results in this population. Objective. Examination of variables associated with achievement of HbA1c goal in children and adolescents with newly diagnosed type 1 diabetes. Methods. The primary outcome, factors associated with achievement of HbA1c goal, was examined in a retrospective chart review. Variables, including type of basal insulin, were collected during the first year of diagnosis of patients in a pediatric diabetes clinic. Secondary outcomes included change in HbA1c, severe hypoglycemic events, and episodes of DKA. Results. 94 patients were included in the study. HbA1c at diagnosis was found to be a significant predictor of achievement of goal at 3 months ( ) and of change in HbA1c at 3 and 12 months ( for each). Severe hypoglycemia and episodes of DKA were uncommon. Conclusions. Choice of basal insulin was not found to be a predictor of achieving HbA1c goal or of change in HbA1c over the course of the first year of diagnosis with type 1 diabetes. 1. Introduction In patients newly diagnosed with type 1 diabetes, clinicians have three choices of basal insulin: NPH or one of two insulin analogs, glargine and detemir. While NPH is the traditional choice, the insulin analogs better mimic natural insulin secretion. In a meta-analysis, Monami and colleagues found that the use of glargine and detemir resulted in decreased hemoglobin A1c (HbA1c) and a reduced risk of nocturnal and severe hypoglycemia when compared to insulin NPH [1]. The American Diabetes Association recommends the use of insulin analogs in many patients with type 1 diabetes, particularly those in whom hypoglycemia has been a complicating factor [2]. The choice of long-acting analog in newly diagnosed patients with type 1 diabetes is less clear. Several studies have measured pharmacokinetic and dynamic endpoints. A study in patients with type 1 diabetes demonstrated that while the activity of glargine and detemir was initially similar, after 12 hours detemir¡¯s effects decreased significantly, and the average end of action was 17.5 hours compared to glargine¡¯s 24 hours [3]. Detemir has been found to have a dose-dependent duration, with lower doses having a shorter duration of action. It is also possible that the duration of action will be attenuated in children and adolescents with type 1 diabetes [4]. However, Heise and colleagues found that, when compared to insulin NPH and glargine,
%U http://www.hindawi.com/journals/isrn.pediatrics/2014/758343/